Providing online counseling for home-based HIV testing.

描述（由申请人提供）：在美国艾滋病毒流行中，男男性行为者（MSM）仍然是受影响最大的风险群体。研究表明，大多数男男性接触者的艾滋病毒感染事件可归因于与主要男性性伴侣发生性行为；然而，缺乏针对男女伴侣的艾滋病毒预防干预措施。正因为如此，夫妻艾滋病毒自愿咨询和检测（CVCT），一种被反复证明可以减少异性恋夫妇之间艾滋病毒传播的干预措施，已被适用于美国男同性恋者夫妇。针对男同性恋夫妇的CVCT现已在美国11个城市推出。美国食品和药物管理局最近批准了家庭艾滋病毒检测：然而，批评者指出缺乏咨询，特别是对那些接受艾滋病毒检测呈阳性的人。拟议的活动包括将家庭艾滋病毒检测和CVCT创新性地结合起来。这些活动调查了家庭艾滋病毒检测与视频skype操作的CVCT会话的效用，由远程CVCT咨询师操作。通过对来自美国各地的1300对在线招募的男同性恋夫妇进行筛选，并在随机对照试验中招募了600名男同性恋夫妇，该研究旨在检查家庭艾滋病毒检测加上视频skype操作的CVCT会话（实验条件）与单独家庭艾滋病毒检测（对照）在减减性冒险，性协议的形成和遵守，以及管理男同性恋夫妇关系中艾滋病毒风险的关系功能方面的影响。建议的活动检查干预对自我报告的血清和谐阴性夫妇（n=300）和自我报告的血清不和谐夫妇（n=300）的影响。作为次要目标，这些活动建议调查家庭艾滋病毒检测加上视频skype操作的CVCT会议对及时联系到艾滋病毒初步阳性结果感染者的影响。夫妻将完成基线、3个月和6个月的随访问卷，详细说明最近的性风险、衡量双方在艾滋病毒风险管理方面的沟通和应对的量表，以及关于关系外性行为的协议。研究人员假设，在家庭检测中加入skype操作的以夫妻为中心的咨询会议，将有助于增加应对机制和沟通，从而有效管理关系中的艾滋病毒风险，并将减少关系内外的性风险，对于那些接受艾滋病毒阳性检测结果的人来说，将增加及时的联系。通过Skype提供的CVCT提供了一个廉价的机会，使以夫妇为重点的干预措施能够推广到更广泛的受众，并为那些进行家庭艾滋病毒检测的人提供了一种接受咨询的机制。

DESCRIPTION (provided by applicant): Men who have sex with men (MSM) continue to be the most heavily-impacted risk group in the US HIV epidemic. Studies suggest that the majority of incident HIV infections among MSM are attributable to sex with a main male sex partner; however, HIV prevention interventions that target male-male couples are lacking. Because of this, Couples HIV Voluntary Counseling and Testing (CVCT), an intervention that has been repeatedly shown to reduce HIV transmission within heterosexual couples, has been adapted to US MSM couples. CVCT for MSM couples is now available in 11 US cities. The FDA recently approved home-based HIV testing: however, critics have pointed to the lack of counseling involved, particularly for those who receive a positive HIV test. The proposed activities include an innovative combination of home-based HIV testing and CVCT. The activities investigate the utility of home-based HIV testing combined with a video-Skype operated CVCT session, operated by a remotely located CVCT counselor. Through the screening of 1300 online recruited MSM couples from across the US and the enrollment of 600 in a RCT, the study aims to examine the impact of home-based HIV testing PLUS a video-Skype operated CVCT session (experimental condition) versus home- based HIV testing alone (control) on reductions in sexual risk-taking, formation of and adherence to agreements around sex, relationship functioning for the management of HIV risk in relationships among MSM couples. The proposed activities examine the impact of the intervention on self-reported sero-concordant negative couples (n=300) and self-reported sero-discordant couples (n=300). As a secondary aim, the activities propose to investigate the impact of home-based HIV testing plus a video-Skype operated CVCT session on timely linkage to care for those receiving a preliminary positive HIV result. Couples will complete baseline, 3 month and 6-month follow-up questionnaires, detailing recent sexual risks, scales to measure dyadic communication and coping around HIV risk management, and agreements around sex outside of the relationship. The researchers hypothesize that adding a Skype-operated couples-focused counseling session to home-based testing will act to increase coping mechanisms and communication for the effective management of HIV risks in relationships and will lead to reductions in sexual risk taking both within and outside of the relationship and for those receiving a HIV positive test result will increase timely linkage to care. CVCT provision through Skype offers an inexpensive opportunity for a couples-focused intervention to be taken to a wider audience and to provide a mechanism for those under-taking home-based HIV testing to receive counseling.